Doctor Q&A: Why am I spitting blood in the morning? Dr Renee Hoenderkamp answers your questions

Hi doc, why do I spit blood in the morning? It's not deep thick red blood. It's just light red and in my saliva. Naturally, my head is going to the worst place but just wanted to get your thoughts. I am not coughing it up and I desperately need to go the dentist..  Could it be a gum issue? I also don't have any other health issues. Any clarification would be really appreciated it. 

I’m no dentist but I think you have answered your own question… it sounds very much like a dental problem. Why do I say this?

You state clearly that you are not coughing it up and it is in your saliva. But just before I talk about gums and their importance it is important to say that coughing up blood is a red flag for several serious conditions and must be investigated by your doctor. Coughing up blood could indicate a problem in your lungs, throat or stomach and can be a sign of cancer or infectious disease such as TB.

Back to teeth. Spitting up blood in the morning that is coming from the mouth can be caused by gum irritation caused by a build-up of plaque around the tooth/gum line which leads to infection and gingivitis. Regular brushing and flossing can keep this plaque at bay but if things have really built up you may need a helping hand from the dental hygienist.

People that clench their teeth (bruxism) can cause pressure on the gums as they clench in their sleep and this can cause bleeding.

Your nose bleeding overnight can cause blood in your saliva as can blood-thinning medications.

Mouth ulcers, cracked teeth that cause wounds and even mouth or throat cancer can result in blood in your saliva, even without coughing, so it is important to see a dentist for a diagnosis and perhaps your doctor too if there is any doubt that it is a tooth issue.

And if it is just poor dental condition that you are dealing with, there is good reason to get those pearlies in tip-top condition. There is a direct relationship between the state of your oral health and overall health. Plenty of studies have shown that the number of healthy, well-maintained teeth you have later in life can affect your longevity and life expectancy. In fact, research shows that those around 75 years old who still have a full set of teeth are most likely able to make it to 100 years old!

So to summarise; please see a dentist immediately. If they can’t see an obvious cause, see a doctor, or for completeness see both. Take their advice and get into good dental health habits, it will pay off in the long term.

Hey Doctor Renee, love watching you on GB! I have quite a specific question but honestly quite desperate at this point. A year ago today I was diagnosed with B12 deficiency. Despite receiving intramuscular injections the shooting pains in my feet seem to be getting worse. Keep me up most nights. Will the pain ever stop? If you know of any intervention that could help I will eternally grateful. Thank you  

I am sorry to hear this. For those who don’t know, being deficient in vitamin B12 can cause peripheral neuropathy (a problem with the nerves in the hands and feet). Reversing the B12 deficiency via tablets or injections (depending on the severity and cause) can reverse the problems that it causes.

Having said this, it needs to be done within a certain time frame to guarantee resolution of the symptoms and this is estimated by some studies to be within six months of symptoms starting. Thereafter it can take six to 12 months for things to improve. But as you have been on replacement for a year I think it's time for you to ask your GP for a referral for nerve conduction studies to see what’s happening in your feet. You also need blood tests to ensure your levels are in normal range and preferably in the upper end of the range.

In terms of making sure you get enough dietary B12, make sure you are getting plenty of animal products (beef, venison, chicken, eggs, milk), liver, clams, bananas, mackerel, salmon and offal.

It is also worth considering other causes for your pain. For example, sciatica, cramps, vascular problems, and restless legs.

I try always to give an alternative to try whilst you investigate the things raised above and there is some decent data for a supplement called Acetyl-L-carnitine which people often use when having chemotherapy to guard against and help with peripheral neuropathy. There is a study showing that compared to placebo, Acetyl-l-carnitine (ALC) produced a significant pain reduction equal to 20.2 per cent with respect to baseline.

Clinical trials also showed beneficial effects on nerve conduction parameters and nerve fibre regeneration, with a good safety profile. So it has to be worth a try but please speak to your doctor about any interactions with other medications you are taking.

Good luck.

Hello doctor, can taking too many antibiotics mess up your immune system? I ask because my mum used to give me them as soon as I had any sign of a cold. I'm now an adult and I constantly catch anything going around. I'm convinced the two are linked but I might be wrong. I'd love to get your take on this. Regards 

This is such an interesting question and one of the reasons I try and rarely prescribe antibiotics! The short answer is yes they can indeed affect your immune system and do many more things that we would seek to avoid, or should! For example there is evidence to suggest that maternal and early-life antibiotic use was associated with an increased risk of autism and ADHD in childhood. So whilst these studies may be inconsistent, they do suggest that an ‘only when absolutely necessary’ approach to antibiotics would be wise. Notwithstanding that antibiotics can’t help viral colds or flu at all.

Returning to your question, the reasons that antibiotics affect immunity are twofold:

1. Too many antibiotics can allow the development of antibiotic resistance making hard to treat infections more common

2. 80 per cent of immune cells are in the gut and taking antibiotics wipes out the healthy gut bacteria whose job it is to create a healthy gut environment for this delicate but crucial relationship.

If one takes an antibiotic it can take a few months for the gut microbiome to return and Tim Spector from Zoe states that he has witnessed it taking two years. And this of course depends on replenishing the gut with the kind of food input that encourages good bacteria over bad.

To this end, you can only deal with what is and it is never too late to encourage a good gut microbiome and the kind of foods to help include:

• Eating more foods high in fibre and polyphenols, such as fruits, vegetables, nuts, legumes, and whole grains.

• Adding more fermented foods to your diet, including yoghurt, kimchi, kombucha, kefir, sauerkraut.

• Avoid excess saturated fats, artificial sweeteners, and processed meats/foods.

• Cooking from raw at home and avoiding ready meals

• Adding a good probiotic

In terms of the probiotic, the one I take and always recommend is Symprove, it’s the one proven to actually reach the colon and not get destroyed by acidic stomach acid. It’s a 70ml drink taken each morning and as a food supplement, there is no downside.

This is such a massive topic and one in which I have a particular interest so I hope this is a good snapshot and that you can get your good bacteria back in control.